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Best Practice Guidelines Insulin Administration

Teaching Injection Technique To People With Diabetes

Teaching Injection Technique To People With Diabetes

January 2017 For people with diabetes who take insulin or other injectable diabetes medications, the diabetes educator can teach evidence-based standardized methods to improve clinical outcomes. The diabetes educator can enhance and maximize:  Patient engagement in self-care management  An understanding of the action of the medication  The comfort of the injection  Safe and effective medication dosing including when and how to take  Site inspection and rotation to decrease absorption variability While discussions regarding insulin and other treatment algorithms to improve glycemic control is ongoing, the aim of this advisory is to outline best practices for subcutaneous injection technique that should be covered by diabetes educators when teaching patients how to inject diabetes medications. State laws regulate which healthcare professionals are authorized by their license to provide hands-on instruction for injection administration. As with any type of patient education, it is essential to individualize the educational needs assessment (determining what the patient already knows/does, as well as exploring fears and barriers to self-care) and to make accommodations for patient literacy and numeracy levels, cognitive and visual abilities, and other impairment issues. The educator should assess the patient’s skills and understanding by observing teach-back and having the patient describe an action plan. Recommended Topics:  Education about injection technique for delivery of insulin, including a review of hypoglycemia (causes, detection, treatment and prevention) as well as when to check blood glucose and individualized pre and post meal targets  Periodic review of injection technique and sites, especially when blood Continue reading >>

Diabetes Mellitus

Diabetes Mellitus

See also: Background: Diabetic ketoacidosis (DKA) is the combination of hyperglycemia, metabolic acidosis, and ketonaemia. It may be the first presentation for a child with previously undiagnosed diabetes. It can also be precipitated by illness, or poor compliance with taking insulin. All patients presenting with a blood glucose level (BGL) ≥ 11.1mmol/l should have blood ketones tested on a capillary sample using a bedside OptiumTM meter. If this test is positive (>0.6 mmol/l), assess for acidosis to determine further management. Urinalysis can be used for initial assessment if blood ketone testing is not available. The biochemical criteria for DKA are: 1. Venous pH < 7.3 or bicarbonate <15 mmol/l 2. Presence of blood or urinary ketones If ketones are negative, or the pH is normal in the presence of ketones, patients can be managed with subcutaneous (s.c.) insulin (see ' new presentation, mildly ill' below). Assessment of children and adolescents with DKA 1. Degree Of Dehydration (often over-estimated) None/Mild ( < 4%): no clinical signs Moderate (4-7%): easily detectable dehydration eg. reduced skin turgor, poor capillary return Severe(>7%): poor perfusion, rapid pulse, reduced blood pressure i.e. shock 3. Investigations Venous blood sample (place an i.v. line if possible as this will be needed if DKA is confirmed) for the following: FBE Blood glucose, urea, electrolytes (sodium, potassium, calcium, magnesium, phosphate) Blood ketones (bedside test) Venous blood gas (including bicarbonate) Investigations for precipitating cause: if clinical signs of infection consider septic work up including blood culture For all newly diagnosed patients: Insulin antibodies, GAD antibodies, coeliac screen (total IgA, anti-gliadin Ab, tissue transglutaminase Ab) and thyroid function Continue reading >>

Best Practices For Injecting Insulin And Inserting Infusions

Best Practices For Injecting Insulin And Inserting Infusions

How you inject insulin or insert an infusion set can have a big impact on how insulin is absorbed in your body. A team of experts on injections and infusions have outlined new comprehensive recommendations on strategies for injecting and inserting infusions for people with diabetes. These recommendations have been published in the Mayo Clinic Proceedings. They were sparked by a large international survey of current practice and were then written and vetted by 183 diabetes experts from 54 countries at the FITTER workshop in Rome, Italy in 2015. Many people with diabetes rely on insulin, but something that is often overlooked yet, crucial are the factors involved in injecting insulin or inserting infusions. If the correct method isn’t used, insulin therapy may be negatively impacted which may prevent blood sugar management. Everyone can use a 4mm long needle. Children have slightly less thick skin as adults until they go through puberty. The 4-mm needle length for both injections and infusions work to get through the skin and access the subcutaneous fat where insulin needs to be delivered, even in obese persons. Needles shorter than 4-mm are not recommended. The safest currently available syringe needle for all patients is 6-mm needle. Children using a 5-mm pen needle should be switched to 4-mm pen needles and if they cannot, they should use a lifted skin fold to inject. Be careful not to inject into muscle. Care needs to be taken in children and thin individuals in order to avoid intramuscular injections since this can lead to unexpected low blood sugar episodes due to faster insulin absorption. Injections into muscle can also lead to unnecessary pain, bruising, and bleeding. Be sure to take inconsideration the amount of fat in an area, the length of a needle, and the Continue reading >>

Knowledge Translation Of Insulin Use Interventions / Safeguards

Knowledge Translation Of Insulin Use Interventions / Safeguards

ISMP Canada, with support from the Ontario Ministry of Health and Long-Term Care, undertook a knowledge translation project on insulin use interventions and safeguards based on learnings from the Ontario Critical Incident Learning Program. As part of this project, ISMP Canada convened an expert panel to select 2 key insulin-use interventions and then asked expert working groups to develop specific guidelines and templates to support the selected key interventions. INTERVENTIONS 1. Develop and implement a diabetes management record: Create a record where all relevant aspects of a patient's glycemic management can be documented to facilitate decision-making with regard to insulin therapy. Information to be documented in this record includes results of blood glucose testing, details of every insulin dose administered, nutritional status, occurrence of hypoglycemic episodes, and other factors that may affect blood glucose. 2. Use standard order sets for subcutaneous insulin therapy: Develop organization-wide, evidence-based standards and standardized terminology for ordering subcutaneous insulin. Develop recommendations for prescribing and monitoring subcutaneous insulin. Discourage the use of sliding-scale insulin alone. Promote the use of scheduled basal and bolus insulin doses, as well as appropriate correction doses. Report to the Ontario Ministry of Health and Long-Term Care: Knowledge Translation of Insulin Use Interventions / Safeguards - PDF ISMP Canada Guidelines for Subcutaneous Insulin Order Sets - PDF *The documents are provided solely for illustration, instructional purposes, and general information and convenience. Appropriate qualified, professional advice is required to apply any of this information to a specific health care setting or organization. *Any rel Continue reading >>

Insulin Administration

Insulin Administration

Insulin is necessary for normal carbohydrate, protein, and fat metabolism. People with type 1 diabetes mellitus do not produce enough of this hormone to sustain life and therefore depend on exogenous insulin for survival. In contrast, individuals with type 2 diabetes are not dependent on exogenous insulin for survival. However, over time, many of these individuals will show decreased insulin production, therefore requiring supplemental insulin for adequate blood glucose control, especially during times of stress or illness. An insulin regimen is often required in the treatment of gestational diabetes and diabetes associated with certain conditions or syndromes (e.g., pancreatic diseases, drug- or chemical-induced diabetes, endocrinopathies, insulin-receptor disorders, certain genetic syndromes). In all instances of insulin use, the insulin dosage must be individualized and balanced with medical nutrition therapy and exercise. This position statement addresses issues regarding the use of conventional insulin administration (i.e., via syringe or pen with needle and cartridge) in the self-care of the individual with diabetes. It does not address the use of insulin pumps. (See the American Diabetes Association’s position statement “Continuous Subcutaneous Insulin Infusion” for further discussion on this subject.) INSULIN Insulin is obtained from pork pancreas or is made chemically identical to human insulin by recombinant DNA technology or chemical modification of pork insulin. Insulin analogs have been developed by modifying the amino acid sequence of the insulin molecule. Insulin is available in rapid-, short-, intermediate-, and long-acting types that may be injected separately or mixed in the same syringe. Rapid-acting insulin analogs (insulin lispro and insulin a Continue reading >>

Cdc Clinical Reminder: Insulin Pens Must Never Be Used For More Than One Person

Cdc Clinical Reminder: Insulin Pens Must Never Be Used For More Than One Person

CDC Clinical Reminder: Insulin Pens Must Never Be Used for More than One Person The Centers for Disease Control and Prevention (CDC) has become increasingly aware of reports of improper use of insulin pens, which places individuals at risk of infection with pathogens including hepatitis viruses and human immunodeficiency virus (HIV). This notice serves as a reminder that insulin pens must never be used on more than one person. Insulin pens are pen-shaped injector devices that contain a reservoir for insulin or an insulin cartridge. These devices are designed to permit self-injection and are intended for single-person use. In healthcare settings, these devices are often used by healthcare personnel to administer insulin to patients. Insulin pens are designed to be used multiple times, for a single person, using a new needle for each injection. Insulin pens must never be used for more than one person. Regurgitation of blood into the insulin cartridge can occur after injection [ 1 ] creating a risk of bloodborne pathogen transmission if the pen is used for more than one person, even when the needle is changed. In 2009, in response to reports of improper use of insulin pens in hospitals, the Food and Drug Administration (FDA) issued an alert for healthcare professionals reminding them that insulin pens are meant for use on a single patient only and are not to be shared between patients [ 2 ]. In spite of this alert, there have been continuing reports of patients placed at risk through inappropriate reuse and sharing of insulin pens, including an incident in 2011 that required notification of more than 2,000 potentially exposed patients [ 3 ]. These events indicate that some healthcare personnel do not adhere to safe practices and may be unaware of the risks these unsafe pr Continue reading >>

Insulin Injection And Injection Site Rotation Best Practices For Ltc Pharmacy Services

Insulin Injection And Injection Site Rotation Best Practices For Ltc Pharmacy Services

Long-term care pharmacy services aren’t limited to the dispensing of oral medications—vaccines and insulin injectables are also among the items dispensed. Staying up-to-date on the latest findings related to injections is key for LTC pharmacy services providers. Blood glucose control can be a challenge in our geriatric resident population for a variety of reasons. As we age, a number of factors can affect blood glucose management, ranging from physiological changes and erratic nutritional intake to impaired renal or hepatic function to variable physical activity and even polypharmacy. Trying to pinpoint the culprit of blood glucose swings can be a daunting task. In addition to these common potential sources of blood glucose variability, there are several often-overlooked factors—a person’s skin, insulin injection technique, and injection site rotation practices. Let’s take a look at some important considerations and best practices associated with insulin injection technique and injection site rotation recommend by post-acute care pharmacy providers. LTC Pharmacy Services Best Practice: Why Injection Site Rotation Is important Repeated injection into the same site can cause lipohypertrophy and lipodystrophy. Lipohypertrophy is the buildup of fat under the skin. Subsequent injection into areas of lipohypertrophy can lead to lipodystrophy, which is scarring of the fat. Subsequent injection into areas with lipohypertrophy or lipodystrophy can significantly slow the absorption of insulin. The altered insulin absorption may lead to elevated glucose levels, which may be attributed to insufficient disease management instead of poor insulin administration technique. LTC Pharmacy Services Best Practice: Insulin Injection and Injection Site Rotation Insulin is best absor Continue reading >>

Initiating Insulin For People With Type 2 Diabetes

Initiating Insulin For People With Type 2 Diabetes

Due to its progressive nature, many people with type 2 diabetes will eventually require insulin treatment. Insulin initiation is frequently managed in secondary care. However, New Zealand guidelines now recommend that insulin initiation for people with type 2 diabetes be managed in primary care where possible, with additional support as required. View / Download pdf version of this article Insulin depletion is probable over time Type 2 diabetes is a progressive disease characterised by insulin resistance and a decreasing ability of pancreatic β-cells to produce insulin. Both of these factors contribute to hyperglycaemia. Following lifestyle modifications, most patients with diabetes begin treatment with oral hypoglycaemic medicines. Over time, the efficacy of oral medication frequently diminishes. Treatment with insulin is eventually required, either alone, or more commonly in conjunction with oral medicines such as metformin. It is possible for people with insulin resistance to delay or, in some cases, even avoid the need for insulin treatment through exercise and significant weight loss, however, patients with type 2 diabetes should be made aware at an early stage of treatment, of the probability that they may require insulin in the future. Insulin initiation is often delayed Evidence is accumulating that in all developed countries, many people with diabetes are failing to meet glycaemic targets.1,2 As insulin has a greater blood glucose lowering ability than any other hypoglycaemic medicine, it is important that initiation of insulin treatment is considered in all patients with poor glycaemic control, following appropriate lifestyle changes and the use of oral hypoglycaemic medicines. In the United Kingdom, a large ten year population-based study of treatment practi Continue reading >>

Insulin: From Prescription To Administration

Insulin: From Prescription To Administration

Insulin: from prescription to administration Insulin: from prescription to administration The purpose of this guideline is to support the safe and effective use of insulin at Great Ormond Street Hospital (GOSH). It follows the implementation of the National Patient Safety Agency (NPSA 2010 ) guidance Safer Administration of Insulin and supports best practice throughout the Trust. The aim of this document is to ensure that: The right patient receives the right type and dose of insulin, at the right time by the most appropriate delivery device The most appropriate technique is used to inject insulin with the most commonly used insulin pens The most appropriate insulin syringe is used to prepare insulin for an insulin infusion Diabetes mellitus is a group of metabolic diseases characterised by chronic hyperglycaemia resulting from defects in insulin secretion, insulin action or both. Insulin is a polypeptide hormone produced by the beta cells in the pancreas that plays a key role in the regulation of carbohydrate, fat and protein metabolism. Treatment with insulin in patients with diabetes mellitus, is essential not only to optimise glycaemic control, but also to reverse the abnormalities in fat and protein metabolism caused by the deficient action of endogenous insulin on target tissues and to reduce the development of micro and macrovascular complications. Insulin is lifesaving medication when prescribed and administered appropriately but also has the potential to cause significant harm ( Diabetes Care, 2011 ). It is a high-risk medicine (Institute of Safe Medication Practice, 2008; Patient Safety First, 2013 ). Nationally, incidents related to insulin have been reported at all stages of the medication process, the most common being, wrong dose, omitted or delayed insul Continue reading >>

Guidelines For Optimizing Safe Subcutaneous Insulin Use In Adults

Guidelines For Optimizing Safe Subcutaneous Insulin Use In Adults

Guidelines for Optimizing Safe Subcutaneous Insulin Use in Adults The ISMP Guidelines for Optimizing Safe Subcutaneous Insulin Use in Adults were developed to help healthcare facilities prevent insulin errors and improve patient outcomes by addressing the at-risk behaviors and unsafe practices associated with subcutaneous insulin use in the inpatient setting and during transitions of care. The consensus statements presented in this guidance document are based on the proceedings from a summit held by ISMP in November 2015 of key stakeholders, as well as feedback received through public comment. Agreement was reached regarding common risks associated with subcutaneous insulin use and best practice recommendations for the safe use of subcutaneous insulin in the hospital and during transitions of care. Evidence-based research and regulatory evidence were also used, as available, to support the development of the guidance statements. The guidelines outline the risks associated with subcutaneous insulin use in the following processes: Prescribing, dispensing, preparing, and administering subcutaneous insulin Monitoring patients on subcutaneous insulin Educating patients on subcutaneous insulin The recommendations contained within the safe practice guidelines focus on the following processes: Continue reading >>

The Importance Of Good Insulin Injection Practices In Diabetes Management

The Importance Of Good Insulin Injection Practices In Diabetes Management

Abstract: Abstract Time constraints are often significant when treating patients with diabetes with insulin. In such settings, focus is often placed on the type of insulin the patient is taking, with an even greater emphasis placed on the amount. However, how much emphasis is placed on the practical aspects of insulin use? Is the patient using proper injection techniques? Are the insulin syringes or pens being cared for correctly? Are needles being quietly re-used without the medical staff’s knowledge? Are sharps being disposed of safely? Diabetes education regarding the proper use of insulin takes much time and effort. Without it, however, the appropriate type of insulin at the correct dose might not necessarily give the intended outcome. Instead, marked glycemic excursions could occur, leaving the goal of good diabetes control unachievable and the medical staff baffled. Keywords Diabetes, insulin, injection technique, insulin pens, insulin syringes, insulin needle re-use, patient education Disclosure: Richard Dolinar, MD, is a member of the speakers’ bureaus of Amylin, Eli Lilly, and Takeda and a consultant for BD Medical and Pfizer. Received: October 22, 2009 Accepted: December 2, 2009 Correspondence: Richard Dolinar, MD, Arizona Endocrinology Center, 5130 W. Thunderbird Road, Suite 1, Phoenix, AZ 85306. E: [email protected] When insulin-requiring patients with diabetes are seen in the clinic,there is usually a great emphasis placed on the type of insulin the patient is taking and an even greater emphasis on the amount. However, how much emphasis is placed on the practical aspects of insulin use? Which technique is the patient using to inject the insulin? Is he or she injecting it correctly? What sites are being used? Are the insulin syringes or pens being ca Continue reading >>

Recommendations For Best Practice In Injection Technique

Recommendations For Best Practice In Injection Technique

FIT Forum for Injection Technique Canada Recommendations for Best Practice in Injection Technique Objectives • Identify the injection techniques currently being used in practice amongst Canadian Health Care Professionals (HCPs) and people living with diabetes. • Raise awareness of the impact that existing and emerging research related to injection technique may have on health outcomes. • Facilitate opportunities in which best practice can be discussed, developed, implemented, and evaluated throughout Canada. FIT Canada will provide evidence-based best practice information for all those with diabetes using injectable therapies to achieve the best possible health outcomes by ensuring that the dose is delivered in the right injection site, using the right technique, every time. This will be done through professional and patient education, accessible support and research. 2 Introduction The results of an international survey40 have led to an increasing awareness of the problems associated with inadequate injection techniques. The Canadian FIT initiative has been developed in response to these concerns. Following the precedence set by the United Kingdom FIT 74 as well as other international injection technique documents, 1, 35, 43, 58, 68 this document has been established to promote best practice in injection technique for all involved in diabetes care.43, 58, 68 A meeting of leading experts in diabetes education was held to identify areas of priority in injection technique. The three leading priorities identified were: 1 Avoid intramuscular injections; 2 Ensure healthy injection sites; and 3 Provide clear and concise instruction to health care professionals regarding injection techniques. Utilizing these priorities as a framework, this best practice docum Continue reading >>

Forum For Injection Technique And Therapy Expert Recommendations, India: The Indian Recommendations For Best Practice In Insulin Injection Technique, 2017

Forum For Injection Technique And Therapy Expert Recommendations, India: The Indian Recommendations For Best Practice In Insulin Injection Technique, 2017

Go to: Abstract Health-care professionals in India frequently manage injection or infusion therapies in persons with diabetes (PWD). Patients taking insulin should know the importance of proper needle size, correct injection process, complication avoidance, and all other aspects of injection technique from the first visit onward. To assist health-care practitioners in their clinical practice, Forum for Injection Technique and Therapy Expert Recommendations, India, has updated the practical advice and made it more comprehensive evidence-based best practice information. Adherence to these updated recommendations, learning, and translating them into clinical practice should lead to effective therapies, improved outcomes, and lower costs for PWD. Keywords: Forum for Injection Technique, Forum for Injection Technique and Therapy Expert Recommendations, injection technique, insulin, lipohypertrophy, persons with diabetes Go to: Diabetes and its complications impact the health, well-being, and finances of individual and family. India and China lead the world with the largest number of persons with diabetes (PWD). As per 2015 data, India had 69.2 million people living with diabetes, which is projected to reach 87 million by 2030.[1,2] Recently, there has been increased emphasis on optimal insulin therapy and blood glucose control in type 2 diabetes mellitus (T2DM). A few PWD, however, realize that correct insulin injection technique is as important in achieving glycemic goal as the type and dose of insulin delivered.[3] Incorrect choice of injection site, delivery devices, and technique may modify insulin absorption parameters, leading to disconnect between maximum glucose load and peak insulin effect. This leads to either glycemic variability or unexplained hypoglycemia and su Continue reading >>

Type 1 Diabetes Mellitustreatment & Management

Type 1 Diabetes Mellitustreatment & Management

Type 1 Diabetes MellitusTreatment & Management Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: George T Griffing, MD more... Patients with type 1 diabetes mellitus (DM) require lifelong insulin therapy. Most require 2 or more injections of insulin daily, with doses adjusted on the basis of self-monitoring of blood glucose levels. Long-term management requires a multidisciplinary approach that includes physicians, nurses, dietitians, and selected specialists. In some patients, the onset of type 1 DM is marked by an episode of diabetic ketoacidosis (DKA) but is followed by a symptom-free honeymoon period in which the symptoms remit and the patient requires little or no insulin. This remission is caused by a partial return of endogenous insulin secretion, and it may last for several weeks or months (sometimes for as long as 1-2 years). Ultimately, however, the disease recurs, and patients require insulin therapy. Often, the patient with new-onset type 1 DM who presents with mild manifestations and who is judged to be compliant can begin insulin therapy as an outpatient. However, this approach requires close follow-up and the ability to provide immediate and thorough education about the use of insulin; the signs, symptoms, and treatment of hypoglycemia; and the need to self-monitor blood glucose levels. The American Diabetes Association (ADA) recommends using patient age as one consideration in the establishment of glycemic goals , with targets for preprandial, bedtime/overnight, and hemoglobin A1c (HbA1c) levels. [ 5 ] In 2014, the ADA released a position statement on the diagnosis and management of type 1 diabetes in all age groups. The statement includes a new pediatric glycemic control target of HbA1c of less than 7.5% across all pediatric age groups, replacing e Continue reading >>

Changing Practice For Safe Insulin Administration

Changing Practice For Safe Insulin Administration

Errors in insulin administration are common and can cause harm and even death. An audit aimed to standardise insulin syringe storage and labelling to improve safety Continue reading >>

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